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General NPI Number Information
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NPI Number | 1437887189
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Entity Type | Organization
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Legal Business Name | BEACON BEHAVIOR CONSULTANTS
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 17161 GRAY PINE PL
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-1504
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Country | US
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Telephone | 909-684-2987
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Fax |
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Provider Business Mailing Address
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Address Line | 17161 GRAY PINE PL
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-1504
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | NINA DOLLENTE
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Credential | BCBA
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Telephone | 909-684-2987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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